An ED patient visit often requires many steps, and within and between each step there is potential for improved efficiencies.
Diagnostic Testing
Diagnostic testing and specialty consultations can often create bottlenecks in ED flow. Turnaround time for labs, imaging, and specialty consults include time involved in ordering testing, any needed patient transportation, time for performance of the test or consultation, and then communication of results back to the treatment team. Point-of-care testing for frequently needed labs and imaging can expedite this process in some cases.1 For more specialized testing that requires moving the patient, having efficient modalities for, and communication pathways about, patient transport can help to improve patient flow.2
Consults
Telemedicine consultations might, in certain situations, be preferred to allow for specialty input without requiring in-person presence of a specialist.3 Another important part of the consultation flow pathway is communication to and from the consulting services, and in complex cases also allowing for communication among consultants – this process can be exceedingly difficult in the ED setting, and could benefit from improved processes. ED throughput can also be improved through coordination with case management and social work embedded in the care process from the earliest steps.3
Communication
Clear and timely communication among the ED team members, and with the lab, radiology, and consultants is critical for optimizing care and efficiency. Reducing administrative and documentation burden can have a big impact on many members of the ED care team. And regardless of the intervention type, working together with ED staff on operational improvements is most likely to effectively improve performance.4
Decision Support Tools
Standardized decision support and clinical pathways can be used to reduce between-provider variability in ordering of tests and admission. Variability in these decisions, and over-utilization of testing and consults by even a small number of clinicians can have large and cascading effects on overall patient flow through the ED. Theoretically, embedding decision support tools into the ED workflow or EMR can be a powerful intervention; however, studies on effectiveness of these tools have shown mixed results.5
References
1. Youssef E, Benabbas R, Choe B, Doukas D, Taitt HA, Verma R, Zehtabchi S. Interventions to improve emergency department throughput and care delivery indicators: A systematic review and meta-analysis. Acad Emerg Med. 2024 Aug;31(8):789-804.
2. Kenny JF, Chang BC, Hemmert KC. Factors Affecting Emergency Department Crowding. Emerg Med Clin North Am. 2020 Aug;38(3):573-587.
3. Ahmed AA, Mojiri ME, Daghriri AA, Hakami OA, Alruwaili RF, Khan RA, Madkhali HA, Almania MM, Hakami ZT, Mashraqi KO, Adawi KA, Alqattan SA, Alharbi AN, Albahlol MA, Moafa AI. The Role of Telemedicine in Emergency Department Triage and Patient Care: A Systematic Review. Cureus. 2024 Dec 10;16(12):e75505.
4. Grant KL, Bayley CJ, Premji Z, Lang E, Innes G. Throughput interventions to reduce emergency department crowding: A systematic review. CJEM. 2020 Nov;22(6):864-874.
5. Joseph JW, White BA. Emergency Department Operations: An Overview. Emerg Med Clin North Am. 2020 Aug;38(3):549-562.
